Ethics Framework development in the South East CCAC Building ethics capacity from frontline to boardroom Carol Ravnaas, South East CCAC Dr. Jennifer Gibson, University of Toronto Joint Centre for Bioethics Dr. Jonathan Breslin, South East CCAC South East Community Care Access Centre 1
Imagine you are Manager of Client Services. Today you received a call from a Care Coordinator with the following challenge: Mrs. Lavine is an 84 y/o French speaking woman who has been receiving home care services after her recent hospitalization. The hospital team thought she needed long term care but her husband of sixty years insisted he would take care of her. Lately, however, he has been interfering with her care, refusing certain interventions and occasionally turning service providers away at the door. What should I do? What would you recommend? 2
Imagine you are on the Senior Management Team (SMT) of ABC Do Good organization. This year, the organization anticipates a ten million dollar shortfall. As a result, the Board and SMT must make decisions about how it will balance its budget. Any decision made will affect the lives of clients, caregivers, partners and staff. How do you decide what services to cut? What factors should influence these decisions? 3
Every day in health care Front line workers, Service Providers, CCAC leaders and Boards of Directors are challenged to consider the impact of decisions they make on the lives of clients and their families and are left trying to answer tough questions What is the right thing to do for clients and their families? Where should resources be used and on whom? How should we decide? 4
Our population is aging, our health system is complex, the demands on the system are greater and the public s expectations of what the health system can do for them are growing. It is more important than ever that we ensure good stewardship of public resources with organizational decision-making that is driven by ethical principles. Valerie Jackson, South East CCAC Board Chair May 2011 6
At the South East CCAC Tough choices are our past, present and future We knew we needed a new way to look at decisions, from front-line to board room We needed something to guide through the maze of competing priorities, values and choices 7
South East CCAC Ethics Journey Our Ethics Journey began in 2010, when we committed to developing a comprehensive Ethics Framework and engaged the University of Toronto Joint Centre for Bioethics to help us. 8
What is an Ethics Framework? Provides a standardized approach to working through ethics issues and making decisions - Accreditation Canada, Governance and Leadership Guidelines G1.3 & LD 1.4 9
Ethics Framework Big-E Ethics Framework: Ethics Program Little-e Ethics Framework: Ethical Decision-making Tool 10
Committing to a Big-E Ethics Framework How an organization defines its core values & mission, identifies areas in which important values come into conflict, seeks the best possible resolution of these conflicts, and manages its own performance to ensure that it acts in accord with espoused values - Pearson et al, No Mission, No Margin, 2008. 11
Key Success Factors Integration Bedside-to-boardroom ( system ) Network of ethics champions & expertise Sustainability Clear goals & priorities ( strategic ) Good dose of prevention capacity-building Dedicated resources Accountability Formal lines of authority/accountability Action plans with evaluation strategy
South East Ethics Framework Project Our overall goal: To develop a balanced Ethics Framework that is integrated, sustainable, & accountable 13
South East Ethics Framework Project 14
Phase 1: Ethics Strategic Planning 1. Current State Review Ethics Needs Assessment - On line survey with input from 241 of 300 staff - Focus groups: staff (10) + external stakeholders (5) Policy Compliance Review 2. Ethics Framework Planning Workshop ~ 50 participants: Board of Directors, Senior Leadership, staff, community partners and networks Three year vision, priorities, and action plan 15
The South East Ethical Framework 16
1. Operational Planning Phase 2: Ethics Program and Service Development 2. Ethics Team Development Senior Leader Ethicist Ethics Facilitators Ethics Forum 3. Ethical Decision-making Frameworks/Tools 17
Priority Areas for Action Creating Conditions for the Ethics Framework to Succeed** Aligning With Partners to Advance Ethics Regional Providing Education and Capacity-building** Engaging Clients Evaluating Ethics Framework Impact Embedding Ethics in Policies 18
Ethics Roadmap 3
Implementation Options 3
Operational Model 21
Operational Milestones & Investments 22
Ethics Team: Roles Ethics Team Senior Director Ethicist Role Accountability; core leadership Ethics expertise; core leadership Ethics Facilitators Ethics integration; local point-persons Ethics Forum Monitoring and evaluation; planning & policy development 23
Ethics Facilitators Both Client & Corporate Service staff Process: Call for interest/nomination, interviews, orientation, confirmation of manager support Selection criteria: Attributes go to person, trusted, good listener Geographic and programme distribution 24
Ethical decision-making tools Difficult Cases (IDEA) Organizational Decisions (A4R) 25
Phase 3. Ethics Core Training and Education 1. Core Ethics Training: Ethics Team - Modular format over 6 months: e.g., ethics awareness, ethical reasoning, ethical decision-making, facilitation skills 2. Ethics Education Sessions: Board & Staff Board: Ethics & good governance; Priority setting and resource allocation Staff: Ethics Awareness, Ethical Decision-making, Informed Consent 26
Our journey continues next steps Transition from JCB to ethicist in Nov 2012 Focus on work required to implement the framework 27
This year s priorities 1. Continue building Ethics Team skills and capacity 2. Develop ethics competence of staff and Board members 3. Provide SE CCAC with tools and processes for resolving ethical issues 4. Lead the development of a values-based culture at SE CCAC 5. Integrate ethical principles into budgeting process
Ethicist s reflections Ethics Team Importance of having the right people for the job Frameworks and tools Cutting through the confusion Development is only the first step
Ethicist s reflections Ethics education Developing ethics capacity/competence is a journey Ethics isn t just about the hard cases Being a good person isn t enough Blind spots and other barriers to ethical action
Has ethics made a difference at the South East CCAC? Helped us to make difficult decisions with appropriate rationale that we can defend and feel ok about Allows identification of ethical dilemmas and need for education sessions and / or policy revision Allows discussion of the issues with the team, the organization, and with colleagues Promotes communication / improved tolerance amongst colleagues and teams 31
Helped with the sustainability challenge. Jonathan has helped us to consider questions from a different point of view & broadened our scope of considerations. Improves moral within teams as there is a sense of increased support. Someone/ team to go to when the issue is convoluted/complex Helped to have the courage to stand up and identify an ethical issue and request involvement from the organization 32
It s a breath of fresh air in very challenging times. The decisions still aren t easy but the conversation seems more mature and thorough in nature 33
Hopes for the Future Continued implementation Increased confidence Ethics in day to day practice Positive impact on patients/families Increased dialogue Improved appreciation of ethics Support for each other
Key lessons Developing an ethics presence and approach is a journey requiring commitment, particularly at the board and senior levels. It is challenging to do broad education given various knowledge levels, consider grouping like needs or departments for education. Ethics requires openness and an explorative spirit. 35
More than ever, today s health care decisions are tough Be it the board room or the front line case scenario Viewing these situations through an ethical lens and applying principled based decision making leads to decisions that are Considerate Defensible Balanced 36
Acknowledgments South East CCAC Board & Senior Team, Ethics Facilitators and Staff JCB Consultation Team Hannah Kaufman, Karen Faith, Shawn Winsor JCB Advisory Committee: Frank Wagner, TCCCAC Dianne Godkin, Trillium Health Partners
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